In The Tack Room Chat. . .
Dr. Christiana Ober
Dr. Ober is a veterinarian at the prestigious Virginia Equine Imaging clinic in Middleburg, Va. Her main interests and specialties are lameness, diagnostic imaging and managing the three-day event athlete. She had additional training in acupuncture from the International Veterinary Acupuncture Society and uses this as a complementary technique for her equine athletes. Dr. Ober is currently serving as the treating veterinarian for the Canadian Equestrian Team in the discipline of three-day eventing under coach David O’Connor. She is pictured here at the World Equestrian Games with Karen O’Connor’s mount Upstage.
Up Next: Janet Brown Foy, FEI I-level dressage judge, USEF S-level dressage judge and USEF R-level Sporthorse Breeding judge. She’ll answer your questions about how to ride the new dressage tests, how to improve your scores at any level and any other question you might have about the sport of dressage.
Send questions to webmaster@chronofhorse.com by January 12, 2007. Include your first name and hometown.
Beth, Sixes, Ore.I have a 6-year-old TB gelding who was recently diagnosed with two small OCD lesions on his right femur. His stifle was injected, and my veterinarian has recommended a month of steady work in order to see if the treatment was effective.
His range of motion is much better, and he is tracking better also, but seems to be uncomfortable after about 20 minutes of work, giving me that “slipped on a banana peel” feeling and becoming very reluctant to go forward under saddle.
Should I force him to do more, or just ride him to the point where he’s uncomfortable? I don’t want to compound his physical problem by adding mental ones–something I may have already done!
Dear Beth,
Your veterinarian’s clinical and lameness exam are going to be the most important factors in knowing how to treat your horse. Some horses have OCD lesions that are not clinical (or not affecting them), while others can be quite lame from them. Some questions to ask are: 1) Most importantly is your horse lame? 2) Does he have effusion (or excessive joint fluid) in his stifle? This would be a sign of joint inflammation. 3) Is the work making him worse (either more lame or more effusion)?
I would say that if your horse is still “asymmetric” or unsound behind after the joint injection, it might be time to get a surgical consult or opinion. It is common to try to inject these joints first, but if the horse doesn’t respond to that, then he may become a surgical candidate. It is very unlikely that if he is still unsound after the injection, that things will improve with more work. I would certainly discontinue work and re-evaluate if the horse is resistant to go forward or uncomfortable.
The stifle is a very complex joint involving many soft tissue structures. What you describe as “slipping on a banana peel” may in fact be upward fixation of the patella and may or may not be related to the OCDs. The two problems can probably be distinguished by noting if there is joint effusion (excessive joint fluid in the joint with the OCD), pain on flexion, and maybe potentially by doing a joint block.
There are two different forms of OCDs in the stifle–sub chondral bone cysts (often in the femoral condyles) or the flaps or fragments of articular cartilage. The management and treatment options can sometimes depend on which kind your horse has. There has been some promising new results shown with intralesional injection of corticosteroids in the bone cysts. This may be a treatment option if your horse falls into this category.
In summary, I would have your veterinarian back out to assess your horse’s response to treatment and talk about other options, but I certainly wouldn’t recommend continuing to work him if he is uncomfortable.
Christine, Toronto, OntarioI am interested in learning more about shivers. Would a horse with a mild case of Shivers still have a chance at being a successful jumper?
Dear Christine,
Unfortunately lots of us are very interested in learning more about shivers! It is a very frustrating and not fully understood disease. The disease seems to be most prevalent in Draft breeds and warmbloods, although all other breeds can be affected. The first thing is to make sure that you have an accurate diagnosis of shivers from your veterinarian. This disease can also be mistaken for stringhalt or upward fixation of the patella. Horses affected by shivers appear to have a “hyperflexion” of the limb. Often times the leg is held up in a flexed position sometimes with a raised tail for several seconds. Occasionally this is accompanied with muscle tremors or fasiculations. Sometimes the farrier makes this diagnosis because these horses can be very difficult to shoe.
This “shivers” activity is most evident when the horse is backing or turning tightly or just asked to pick up his limb. It is most often not evident at trot or canter. Sometimes lack of exercise, cold weather or nerves can make the signs clinically worse.
We don’t really know what causes the disease. They have been unable to see evidence of nervous system disease in these horses. Some affected horses seem to be also affected with EPSM (equine polysaccharide storage myopathy). This is why dietary therapy (high fat, low starch and sugar diet) is sometimes successful. Also, these horse seem to do better when they are kept in constant exercise.
Many of these horse can go on to have successful athletic careers such as in the jumper ring. The only unknown is how quickly and if the disease will progress. Often times it starts in the hindlimbs but can progress to the frontlimbs. As long as the horse is only mildly affected he should be able to continue to perform.
Alyssa, Olney, Md.My horse was successfully treated for ulcers, and I now have him on an antacid product (U-Gard). Is this a product I can safely use on a long-term or permanent basis? I have read a bit about acid rebound, is this something to worry about? Also, should I recalculate the Ca:Ph ratio in my horse’s diet?
Dear Alyssa,
Unfortunately, gastric ulceration is a very common problem in performance horses. I am assuming when you talk about treatment for gastric ulcers, that your horse was treated with omeprazole (Gastrogard or Ulcerguard) for a period of at least 30 days and then was potentially scoped to assure healing of the ulcers. There are multiple classes of drugs used in treating gastric ulcers including proton pump inhibitors (omeprazole), histamine type 2 receptor antagonists (ranitidine, and cimetidine), sucralfate and antacids. By far and away the most effective product is the proton pump inhibitor or omeprazole. This is due to the fact that the horse is a continual acid secretor. This makes it critical that the drug affects the pH and the acid secretion well after its time of administration. Omeprazole binds irreversibly to the enzyme that is responsible for the secretion of acid in the stomach. It has been shown that administration of omeprazole once a day affects gastric acid secretion for 24 hrs. Because of this longer acting affect, omeprazole allows the stomach to heal. The efficacy of the other treatments is not nearly as good.
This brings us to the discussion of antacids, which are products that a lot of horse owners like to use. However the acid neutralizing capacity of antacids in horses have not been well documented, and, more importantly, the duration of effect is very short. In most cases it is thought that duration of antacid effect is somewhere between 15 to 30 minutes. You can see how in a horse which is a continual acid secretor this therapy may not be too effective. Most antacids are either composed of aluminum or magnesium hydroxide. Combination products (aluminum and magnesium) may be more effective. We should be careful however in timing of the antacids. Antacids can decrease the bioavailability of the H2 receptor blockers. So, if your horse is currently on ranitidine or cimetidine, the antacid should be given at least an hour after these medications. Additionally there is some thought that the antacid might be slightly more effective when given on a full stomach after feeding. This is because food delays gastric emptying and allows the antacids more time to act.
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The adverse effects that you are talking about with calcium and phosphorous have to do with the aluminum antacids. Aluminum antacids reduce the absorption of dietary phosphorous and may lead to secondary urinary or GI calcium loss. It is very important to remember that all of these studies and adverse effects have been documented in humans. Adverse effects of antacids in horses have not been reported and they have a very different GI system.
So, in summary and in my opinion, the information that we have now does not suggest that antacid therapy is a very valuable tool in the horse in dealing with preventing gastric ulcer disease. It is certainly safe for you to continue using the antacid, but I suspect it is not all that effective. I think the most potent treatment and preventative tool and medication in the horse is omeprazole. Obviously the big down side to this therapy is cost. The way that I use it in my practice is: if I have a horse that I suspect has gastric ulcers, or that we have scoped and documented to have gastric ulcers, we treat that horse with one full tube of Gastrogard once daily. After the initial 30 day treatment course we will specialize a plan for that individual horse. Many of these horses need to go on the preventative dose of ¼ tube once daily when they travel or during exceptionally stressful times of the season. Some of these horses begin to show signs attributable to gastric ulcers at exactly the same time each season. In my opinion your money is probably better spent saving up the money you would use on annual antacids to use specific and targeted omeprazole therapy during the appropriate times. However if the antacids appear to clinically be helping your horse (judging from attitude and behavior), then you are causing no harm by continuing therapy.
Hope this helps ☺
Liz, Kirkville, NYWhat is your favorite care regime to keep older horses or horses with a lot of mileage who are showing signs of joint pain and arthritis comfortable? My teenage gelding has had some significant changes on his radiographs within the last year including some fusing of his lower joints and new this year, a spur on his upper hock joint on one side. He is still in consistent work, although the intensity is much lighter due to his pain level. What supplements or medications do you recommend for older “experienced” horses?
Dear Liz
You ask some very good questions, many of which we are asked very frequently because we deal with a lot of mature or older sport horses. Osteoarthritis or degenerative joint disease is very common in this population. Many of your questions and the maintenance plan I would recommend is dependant upon the job you are asking your horse to perform.
Let’s just assume he is an older horse used for dressage or lower level eventing. In this case a thorough examination by your veterinarian to isolate the main joints causing the pain would be critical. This exam might include watching the horse move, flexion tests, radiographs (as you have described) and maybe some blocking. After you have a diagnosis such as arthritis or the start of fusion of the lower hock joints (which is a severe form of arthritis), then you could discuss treatment options. In horses with significant pain and inflammation associated with their lower hock joints, I find that intra-articular medication or joint injections with a combination of corticosteroids and hyaluronic acid are by far and away the most successful way to maintain these horses. Hopefully you could get away with doing this therapy every 6-12 months. If either the need for therapy was becoming more frequent than that or the joint space was difficult to inject due to the arthritic change, you could investigate other options such as high energy shock wave therapy or IRAP therapy. I would also think it would be beneficial to have your horse on a good oral joint supplement such as Cosequin or Corta-Flex (with glucosamine and potentially hyaluronic acid). Injectable joint supplements such as Adequan and Legend are also very beneficial, but for the cost of weekly administration joint injections might be much more feasible.
If your horse is more a pet or a pleasure horse, then you may be able to try an oral joint supplement as described above and occasional Bute therapy (1 gram two times daily for no more than 5 days in a row) during times of hard work. However, realize that the bute can have detrimental effects on the stomach–such as gastric ulcers.
My maintenance plan for your horse would be most dependant on his workload and how much you are going to be asking him to do. With the radiographic changes you are describing, lower hock joint injections might be the first thing to pursue.
Hope this helps. Good luck keeping your older guy going. Luckily, we have lots of new therapies to keep our older horses more comfortable for longer.
Sarah D.Do you recommend oral joint supplements for horses who are in regular training, and if so starting at what age? What is the best arthritis preventive routine for a younger horse in hard work?
Also, what kind of treatments are you currently recommending for treating hock arthritis, I know there are some new treatment options available such as shockwave and IRAP and would like to know which treatments you use in which cases, how long each is effective, etc.
Dear Sarah,
There has obviously been much research and discussion about oral joint supplements in the horse. Just this year at the recent American Association of Equine Practitioners meeting there were three papers presented on the use of glucosamine in osteoarthritis. Despite clinical impressions, it has still been hard to document that glucosamine is a “structure modifying drug” that can interfere with the progression of disease. Unfortunately to this day, the exact mechanism of glucosamine on cartilage metabolism is not known. One encouraging study (“Effect of Glucosamine and Chondroitin Sulphate on Mediators of Osteoarthritis”- Kirsen M. Neil) did show that glucosamine is “capable of regulating gene expression of some mediators of osteoarthritis.” None of these beneficial effects were shown with chondroitin sulphate.
You must also remember that these products are “neutraceuticals” and are not under the same regulation and quality control of other medications. Therefore there has been much discussion about the outlandish claims of these neutraceuticals on labels of these products and the consistency of the concentration of the glucosamine. All that being said, it does seem like a high quality and consistent glucosamine product has the best rationale as far as an oral joint supplement. I usually recommend either Cosequin or Corta-Flex as a source for daily glucosamine. As far as the age or training level to start these, each horse will be a little different. I would monitor the horse for any signs of osteoarthritis such as swelling or effusion in joints, radiographic changes, positive flexion responses or so on. Certainly a three year old ex-racehorse may be in need of supplements sooner than his warmblood counterpart.
Even though I do recommend an oral glucosamine supplement, I do feel that these are far less effective than other injectable alternatives such as Adequan IM or Legend IV. Many of my older performance horses are on regimes of injectable Adequan and Legend during specific times during the course of the season. I find that the Adequan is most effective given weekly or even bi-weekly (if you really want to spend money ☺) and Legend is effective weekly as well. Unfortunately, I don’t believe there is any good at all in using Adequan or Legend monthly or at a less frequent time period. Something that I recommend if you are on a budget is to feed a good oral joint supplement and save your money to budget for several months during the season (maybe the hardest showing or competition months) of weekly Adequan. Your veterinarian can help you come up with this plan depending on a routine soundness exam and flexion tests.
Now, some of my thoughts on osteoarthritis in the lower hock joints. First of all, let’s limit our discussion to the most common joints affected–the lowest hock joints–the distal intertarsal joint and the tarso-metatarsal joint. Most often this is both a radiographic diagnosis and a clinical diagnosis by the horse’s gait, performance and response to flexion tests. In the case of mild to moderate “spavin” or arthritic change in the lower joints, still the treatment of choice and quite an effective one is intra-articular or joint injections of both of these joints with some combination of steroid (depo-medrol or triamcinilone) and hyaluronic acid. These joints don’t always communicate on injections so it is necessary to usually treat both for best effects. I would hope that if this therapy is working effectively you might get six months of response to injection.
Luckily, because this is such a common problem in the sport horse we do have some other very exciting treatment options. You mentioned two of the ones we most frequently use–high energy shock wave therapy and IRAP (interleukin receptor antagonist protein). Shock wave therapy is an excellent option for those horses that have so much arthritic change that their lower joints are difficult to get into or cannot accommodate an adequate therapeutic volume of the medication. We would be able to determine this group of horses either by radiographs or by trying to inject them and being frustrated with either the lack of response or with the volume we are able to administer. Sometimes we may also use shock wave therapy to prolong the intervals between joint injections. Shockwave therapy eliminates the need to go “into the joint” but is usually somewhat more expensive than routine joint injections. It has been an excellent and successful alternative for that group of horses however. Additionally, shockwave therapy could be used closer to an FEI competition due to the lack of testable medications being put into the horse. According to FEI rules it can be used up to 5 days prior to an FEI competition.
IRAP is a very exciting new therapy. It is considered an “autologous” and “biologic” therapy because it is derived from the horse itself. The goal of the therapy itself is to block the effects of interleukin –1, an inflammatory cytokine that plays a big role in the progression of osteoarthritis. If we can block the interleukin, we can minimize the negative effects toward the development and progression of osteoarthritis. This is very exciting because it may allow us to stop the progression of the arthritis before it becomes chronic. The blood would be pulled from your horse and the serum would be processed by your veterinarian. After 24 hrs of processing, the conditioned and modified serum would be ready for injection into the joint. The process is then just like a routine joint injection. Again this therapy is indicated for FEI level horses closer to a competition because there are not the testing concerns. Additionally, this therapy might become exciting for use in the young horse before chronic changes arise. I have also had horses that did not seem to respond long term to routine joint injections, but got a much longer lasting response to IRAP therapy. It is hard to predict which horses will respond better. It is however exciting that we might be able to manage or slow the course of osteoarthritis without any of the detrimental side effects of corticosteroids.
For more information on both shock wave therapy and IRAP therapy, you can access articles on our website www.vaequine.com. I hope this helps. I know it is a lot of information.
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Jane, Olney, Md.What kind of recovery have you seen after knee bone chip surgery? I know all horses are different, but can a full recovery be expected? And if so, how long until back to “normal” work for them?
Dear Jane,
Unfortunately the prognosis all depends on the individual case. Most importantly, it would depend on how much arthritic change and cartilage damage there has been to the joint. The horse would have a much better prognosis if the surgery was done at the time of the chip (right when it occurred). Unfortunately, if the horse continued to race or work on the joint after the chip, then there would be more likely to be significant degeneration of the cartilage surfaces and the start of arthritis or degenerative joint disease. You can most likely learn about the prognosis by talking to the surgeon to find out what the joint looked like on arthroscopy. Radiographs would also be important to be able to tell you how much arthritic change the horse has post operatively.
If the chip was dealt with early and there was minimal cartilage damage, then the horse would most likely have a good prognosis for a return to an athletic career. Often times these horses have a 12-16 week recovery time, and then they are started back into work. Occasionally after surgery the horse will either have that joint injected with hyaluronic acid or be on a course of Adequan post operatively. It may be a good idea to recheck radiographs before starting the horse back into work. A successful joint post arthroscopically at 12-16 weeks should have minimal effusion (joint fill) or lameness associated with the injury.
If the joint already had excessive cartilage damage or the start of arthritis, then the horse may never come back to athletic performance or he may come back for a short time before the arthritis progresses. Both the surgeon and your veterinarian will probably be able to give you an accurate prognosis for your horse depending on the state of that particular joint.
Samantha, Albuquerque, N.M.I’ve heard that some people use the hormone therapy Depo-Provera in their geldings to control spookiness. Is this effective and what are the risks?
Dear Samantha
In my experience this therapy is not effective at all and not really indicated. I think it is quite a false belief that either Depo-Provera or Regumate is beneficial in performance geldings or stallions to modify behavior. I do not recommend for use in this manner. I do think that hormone therapy has its place in performance mares…but it would obviously be useful more for regulation of estrus or heat behaviors and nothing to do with “spookiness.”
Evelyn, Sarasota, Fla.My 2-year-old has a mild club foot. How do I control it with shoeing and trimming, and what issues could this cause in his future sport horse career?
Dear Evelyn,
You are on the right track in being proactive with your young horse in his shoeing and trimming. The first thing I would recommend is that you get some radiographs of his feet to help guide your farrier. Your veterinarian and your farrier can best work together after reviewing these radiographs to come up with a plan. These radiographs can help assess both balance and angles and give important guidance to your farrier as he is shoeing. I wouldn’t say at this point you can really “control” it or change it, but you can manage it and make sure it doesn’t lead to other problems down the road. These horses can be predisposed to developing dishing of the dorsal hoof wall and the sole can then begin to separate from the white line at the toe.
Club foot is also know as a flexural deformity of the distal interphalangeal joint or coffin joint. It occurs because of contraction of the deep digital flexor tendon which inserts on the bottom of the coffin bone. Most of the therapies and treatments are performed on the very young foal.
Of course, we do see these horses, especially the ones with mild conformational flaws, have quite successful competive careers in different disciplines. However, they do seem to be more predisposed to lameness associated with the distal limb–such as deep digital flexor tendonitis or insertion problems or coffin joint inflammation. The biggest challenge is often managing those horses that have two very different feet–one upright or club foot and one very low heeled foot. This creates quite a shoeing challenge and forces the horse to load his two feet very differently.
At this early stage, by working with your farrier and taking some serial radiographs to assess balance and proper pastern and coffin joint angles you will hopefully minimize some of your problems down the road.
Carrie, Santa Monica, Calif.How concerned are sport horse vets about the recent rhino outbreaks in the racing community? Is there research going on into learning more about this disease?
Dear Carrie,
Wow! Your question turned out to be quite prophetic in nature. I initially wrote my response before the recent rhino outbreak in Wellington…and because it took me a while to finish these questions, I thought I might add some additional thoughts now that we are in the middle of this. As you may well know there has been a recent rhino outbreak in Wellington that is affecting entire horse community. According to a report from the Florida Department of Agriculture and Consumer Services on December 18, five cases of equine herpesvirus type 1 have been confirmed from lab testing from horses quarantined in the Wellington area. Three deaths and 15 clinical cases have been attributed to the disease. The Florida Association of Equine Practitioners has established a veterinary hotline to map out all cases and suspect cases in the area.
All suspect cases are tied to two locations directly linked to the Nov 29th shipment of horses into Wellington. AS OF NOW there are no state restrictions imposed on horses being imported or exported from Florida (ie–the border is not closed). However, currently veterinarians are recommending no shipments of horses in or out of Wellington for at least the next 7-10 days, and then we will reassess. You can get the most up-to-date information from your veterinarian and the Florida Association of Equine Practitioners. Certainly, this is a big concern and veterinarians and owners are working hard to keep this outbreak isolated and quarantined.
All equine vets, especially those working with horses that ship frequently or are exposed to horses that ship frequently, are VERY CONCERNED. Unfortunately these outbreaks are no longer limited to the racing population and are certainly affecting the show horse community as well. We all need to be very, very aware when we are transporting horses. Certainly any horse that develops a fever of unknown origin needs to be treated as possibly infectious and with caution. It is very important to note that many of these affected horses are not coughing or showing other signs. I hope that as vets we are paying special attention to both quarantine and isolation polices. The major source of viral contamination from these horses include nasal discharge and aerosolized respiratory secretions. These horses should be quarantined for 30 days after the last case has been identified.
I just returned from the American Association of Equine Practitioners Convention and there was a lot of talk about these recent outbreaks. Most of the research ongoing is dedicated to early detection and more successful and accurate tests to detect the disease and identify sick horses. They are developing more sensitive nasal swab tests. Hopefully early detection and quarantine of affected horses will minimize the spread.
As a horse owner you have to be very aware of the risks anytime you are shipping your horse or he is exposed to new horses that are shipping. I would recommend careful monitoring of his temperature and contacting your vet immediately if anything is abnormal.
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